Individual provider Active NPI

Jacob Bjorn Heinen, PA

  • Physician Assistant
  • Thornton, CO
National Provider Identifier
1023762945
Registry record updated Jul 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.0007980 Issued in CO
Practice address
8990 Washington St
Thornton, CO 80229-4537
Phone
(720) 929-1655
Fax
(720) 565-4129
NPI assigned
Feb 9, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA.0007980 CO Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

8990 Washington St
Thornton, CO 80229-4537

Mailing address

1735 S Public Rd Ste 203
Lafayette, CO 80026-7093
Phone (303) 665-3036

Other practice location 1

1409 N 121st St
Wauwatosa, WI 53226-3113
Phone (414) 750-4241

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230807000888 CO Practitioner - Physician Assistant 3779944772 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Wisconsin School of Medicine, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1735 S Public Rd
Lafayette, CO 80026-7093
Phone (303) 665-3036

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Clinica Campesina Family Health Services CurrentSince Aug 21, 2023 Accepting new patients
Clinica Campesina Family Health Services Past Accepting new patients

Locations

1735 S Public Rd
Lafayette, CO 80026
Phone 30366530361061

1735 S Public Rd
Ste 203
Lafayette, CO 80026

8990 Washington St
Thornton, CO 80229
Phone (720) 929-1655

8510 Bryant St
Fl 2
Westminster, CO 80031
Phone (303) 854-8004

Interoperability endpoints

  • Direct secure messaging: jacob.heinen.p4@direct.clinicafamilyhealth.nextgenshare.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1644364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689552000000",
    "number": "1023762945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1735 S PUBLIC RD STE 203",
            "city": "LAFAYETTE",
            "state": "CO",
            "postal_code": "800267093",
            "telephone_number": "303-665-3036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8990 WASHINGTON ST",
            "city": "THORNTON",
            "state": "CO",
            "postal_code": "802294537",
            "telephone_number": "720-929-1655",
            "fax_number": "720-565-4129"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1409 N 121st St",
            "address_purpose": "LOCATION",
            "city": "Wauwatosa",
            "state": "WI",
            "postal_code": "532263113",
            "country_code": "US",
            "telephone_number": "414-750-4241",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HEINEN",
        "first_name": "JACOB",
        "middle_name": "BJORN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-02-09",
        "last_updated": "2023-07-17",
        "certification_date": "2023-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0007980",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Thornton, CO

Sources for this page

Verify at the official NPI Registry.